Aetna v. Bay Area Surgical Management

Overview

In this highly publicized matter, Defendant Bay Area Surgical Management (BASM), hatched an insurance fraud scheme that was designed to overcharge Aetna and its plan sponsors to the tune of over $60 million. BASM deployed a three-pronged strategy whereby it would bribe doctors so they would refer Aetna members out-of-network to BASM facilities, misrepresent or waive payment amounts to the patients, and then send inflated bills to Aetna for payment. Aetna brought suit on behalf of its insureds against BASM, its officers, and its facilities to recover the overpayments in full and put an end to Defendants’ exploitation of the health care system.

The Focal Point’s Role

The Focal Point was retained to provide and graphics and trial presentation services for Gibson Dunn and co-counsel. Over the course of the 4-week trial, The Focal Point worked with lead counsel to develop demonstratives for opening statement, expert witnesses and closing arguments. The visual translation of the scheme’s components, the flow of funds from BASM’s complex web of subsidiaries and shell companies to its officers, and creating tutorials on how the health insurance system works were among the many design challenges that, through much collaboration, yielded powerful and persuasive tools that resulted in a complete win for Aetna.

Result

After a month-long trial, the jury quickly returned a unanimous verdict for Aetna and awarded full damages. All Defendants were found liable for conspiracy to engage in fraud against Aetna and its plan sponsors.